Student Data and Evaluation Consent
In order to monitor the effectiveness of the afterschool program and ensure its future success, an independent evaluator is conducting an ongoing evaluation. It is the intention of the evaluation to learn how these after-school services help students, and how they can be improved in order to meet the grant requirements.
Specifically, the Community Partners and the Evaluator, LPB Consulting asks permission to:
- Contact your child’s school to obtain records showing his or her progress, including information about grades and citywide and statewide test scores.
- Survey and/or interview you and your child about the afterschool program and its effects. Any information we collect will be used only to assess the after-school program and will not be made public. Participating in the evaluation will not affect your child in school in the afterschool program, or in any other way. We will not use your name or your child’s name in any report. At the end of the evaluation, we will destroy all records that include personal information. Participation in the study is completely voluntary and participants may withdraw at any time with no consequences. Please select one of the options below.
By selecting YES, I AGREE, I GIVE PERMISSION FOR MY CHILD TO PARTICIPATE. I have read the above information and I give permission for my child to participate in the evaluation of the afterschool program. I also consent for the evaluator and the CBO to obtain my child’s records (IEP’s, progress reports, report cards) and to interview me and my child.
By selecting NO, I DO NOT AGREE, I DO NOT WANT MY CHILD TO PARTICIPATE. I have read the above information and I DO NOT give permission for my child to participate in the evaluation of the afterschool program.
If at any time you change your mind about this decision, you may contact us at any time.
Please make a selection